(Septo)rhinoplasty + turbinectomy
Rhinoplasty is a surgical procedure that aims to improve the function and appearance of your nose. Dr Iseli only performs functional rhinoplasty ie for correction of birth or traumatic defects or as part of improving breathing problems. If you wish to have a rhinoplasty for purely cosmetic reasons, Dr Iseli would be happy to recommend a skilled colleague to you.
Generally, the surgery leaves few or no visible scars. There is usually bruising around the eyes for up to 2 weeks after surgery. Approximately 1 in 10 patients requires another procedure to correct a minor deformity following surgery. Age is a consideration- rhinoplasty is usually not done until the nasal bone growth is complete. This is about age 14 or 15 for girls, and a little later for boys. Additionally, any surgery should be delayed until after any contact sports are ceased. Stop smoking at least four weeks before surgery. This is an excellent time to get help with a smoking cessation program from your GP.
Rhinoplasty is usually performed under a general anesthetic. Most people stay 1 night in hospital but many can go home the same day if they wish. Incisions are hidden inside the nostrils and there is often a small incision on skin between the nostrils. Through these incisions, your surgeon is able to reshape the cartilage and bone. Sometimes a piece of your own cartilage or bone is often used to strengthen or improve the build of the nose. A septoplasty and turbinectomy is usually performed at the same time to improving nasal breathing. Cartilage removed can be used to improve the looks and framework of the nose during the septoplasty.
Generally the risks from rhinoplasty are low however it is important to understand that adverse events can occur after surgery:
· Although 90% will feel their nasal appearance is improved, approximately 3% will feel their nose looks worse
· 10% will require additional minor surgery to correct any abnormal healing result
· Your nose will take 6-12 months to take its final shape. Although bruising will resolve in 2 weeks, you may have swelling (especially in the morning) and numbness for some months. Healing may be uneven and this may improve with time. There rarely may be discomfort, scarring or discoloration over the nose that persists
· Pain is usually minimal unless you touch the nose. It will remain tender to touch for 2 weeks approximately.
· Bleeding. A small amount is expected on the first or second days but should improve. You may use a decongestant (eg oxymetazoline 2 sprays each side twice a day) for up to 3 days to control this. Rarely, bleeding may require packing or a second surgery. Blood transfusion is extremely rare.
· Septal hematoma or bleeding inside the septum is serious and causes severe pain when the nose is not being touched. If you experience this call Dr Iseli’s office or attend an Emergency department. This may have to be drained.
· Infection can be treated with antibiotics.
· Numbness of the top lip and / or upper front teeth is temporary (up to 3 months)
· Adhesions or scar tissue forming inside the nose usually can be fixed in the office during your checkup visit.
· Septal perforation (a hole in the septum). This often is asymptomatic (does not cause problems). It can cause problems such as whistling, crusting or bleeding. Occassionally, another surgery is required to close the hole.
· Persistence or recurrence of nasal blockage. The best procedure can still have a poor result if there are allergies or underlying inflammation.
· Change of taste or smell (uncommon)
· Serious problems from the anesthetic are rare (1:60,000) and include: DVT (Blood clots in the legs), heart attack or a stroke or a reaction to medications.
PREPARING FOR SURGERY
· Discuss your expectations and hopes with Dr Iseli before your surgery. Photographs are required before surgery. These provide Dr Iseli with a reference during the surgery and can be compared to after surgery photos.
· Stop smoking (ideally 4 weeks before surgery)
· Stop decongestants 2 weeks before surgery (try diluting the bottle with boiled water each time it becomes half full until it no longer has any effect)
· Do not eat or drink anything after midnight before surgery (you may have a light breakfast before 6am if your surgery is in the afternoon)
· Avoid aspirin, ibuprofen or naproxen (panadol is OK) for 2 weeks before surgery.
HOME CARE INSTRUCTIONS
· A splint on the top of your nose is used to maintain the new shape of the nose after surgery. Keep this dry until you see Dr Iseli next. The splint will be removed by Dr Iseli 1-2 weeks after the surgery.
· Swelling and bruising around the eyes increases for about two to three days. Keep your head elevated on a couple pillows and sleep with your head elevated. Cold packs to your face will also help keep swelling down. For a cold pack, put some ice cubes in a plastic bag and apply this to your face after wrapping the ice pack in a towel to prevent frostbite. Most swelling and bruising is nearly gone in 2 weeks. The little that remains after 2 weeks is generally unnoticeable to anyone but you.
· After the operation, it is normal to have mild headaches, a stuffy nose or bloody discharge from the nose for 4-6 weeks. There may be sneezing and a plugged or full sensation in the ears.
· Often, dissolving packs are used inside the nose but, occasionally, non-dissolving packs are used that will be removed after one week. The dissolvable packs may fall out like a clot. This is normal and not a cause to worry.
· Take prescribed medication (antibiotics, prednisolone) as directed. Finish all antibiotics if given. Do not use ibuprofen, naproxen or aspirin or any products containing these medications for the first two weeks following surgery. This can increase the possibility of bleeding. Paracetamol (Panadol® or painadeine) may be taken for discomfort. You will be given stronger narcotic medications for use if paracetamol does not control your pain well enough (panadeine forte).
· Cleaning should be performed using saline irrigation, however, over-the-counter nasal saline spray is a second choice. This will help clear the crusts and blood clots in your nose.
· You may gently blow you nose without blocking your nostrils on the 2nd day after surgery. Do not strongly blow your nose for 2 weeks after surgery. Do not touch or knock the nose.
· Avoid strenuous activity such as heavy lifting (more than 5kg), running or sports for 2 weeks. This can cause nosebleeds.
· Elevate your head on a couple pillows when sleeping or lying down.
· Eat a well balanced diet with plenty of fiber to keep your stools soft. This avoids straining which can cause a nosebleed. You may take one tablespoon of Metamucil twice a day in a full glass of water or can take a tablespoon of mineral oil twice a day to help keep your stools soft.
Saline irrigations should ideally be performed on both sides 3x/day for 6 weeks after surgery. Be extremely careful not to knock or bump the nose for 6 weeks- if you find irrigations too hard initially, try a saline spray for the first 2 weeks. Purchase a Sinus Rinse (Neilmed ®) or similar irrigating bottle that may be easily refilled from the chemist. Saline may be purchased or made at home using the following formula:
· 1 teaspoon non-iodized salt (sea salt or cooking salt)
· 1 teaspoon baking soda
· 360mL water
Heat in microwave for 20-30 seconds (until comfortable to drip on hand).
Lean over sink or basin and gently place tip of bottle gently against the opening of the nostril. You should not feel pain touching the nose.
While panting and tilting head over sink, instill ½ bottle into each nostril.
Gently blow nose without blocking nostrils or touching the nose.
Repeat if nose still feels crusted.
Wash bottle after each use with warm soapy water. Store in clean cup with tip down.
Once a week wash bottle with vinegar to prevent bacterial growth.
You may notice some dripping during the day when you tilt your head down.
· Usually you are able to return to school or work within a week but you will need to keep the splint on your nose for 2 weeks approximately.
· Avoid strenuous activities for 2 to 3 weeks. Protect your nose. Avoid unprotected sun exposure for a couple months. Be gentle with bathing.
· Tape your glasses to your forehead or support them with your cheeks until your nose is completely healed.
· If you are a little depressed following surgery, take heart. Day by day your nose will look better. In a couple weeks, cosmetics can be used to cover up signs of the operation. Healing is slow and gradual and final results may not be evident for up to a year.
SEEK MEDICAL CARE IF YOU DEVELOP:
· Redness, swelling, or increasing pain in your nose.
· Purulent (pus-like) discharge or temperature above 38.5 degrees Celsius.
· Vigorous or rapid bleeding from your nose.